WSJ News Exclusive | Walmart, CVS Pharmacies Have Blocked or Delayed Telehealth Adderall Prescriptions

Many pharmacies have procedures for reviewing prescriptions of controlled substances after concerns that the ease of acquiring highly addictive pain medications contributed to the country’s opioid crisis. Pharmacies might have various reasons for not completing a prescription, including that a medicine is out of stock or was prescribed before a previous prescription ran out.

Among those questioning prescriptions from Done is

Walmart Inc.,

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which has blocked some of Done’s clinicians to prevent pharmacists in its stores from filling prescriptions, Walmart confirmed in a statement.

Individual locations of

CVS Health Corp.

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and

Walgreens Boots Alliance Inc.

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have also blocked or delayed prescriptions from Done providers, as have some pharmacies attached to grocery store chains and others, according to people familiar with the actions. CVS has interviewed at least two Done doctors over prescription concerns, the doctors said in interviews. The pharmacy startup Capsule Inc. has also blocked prescriptions for a Done provider in recent weeks, according to the provider.

Done declined to comment. Spokesmen for Walgreens and Capsule outlined the company’s prescribing practices but wouldn’t discuss the decision to block prescriptions. A CVS spokesman said its controlled-substance compliance group interviews clinicians it flags for potentially excessive prescribing practices.

Online mental-health companies Done and Cerebral have grown quickly since they were founded in 2019 and serve tens of thousands of patients between them. Both companies charge patients monthly subscription fees to manage their prescriptions, rates that are higher than what they pay nurse practitioners to manage the patients. They reinvest profits in advertising on Instagram, TikTok, and Google to attract new patients.

Some Cerebral clinicians have similarly had their prescriptions blocked or delayed for Adderall and other controlled substances, including benzodiazepines used to treat anxiety, due to pharmacists’ concerns about the prescriptions, according to people familiar with the company’s operations.

“There have been incidents where prescriptions have been temporarily delayed by pharmacies due to confusion around today’s telehealth policies,” Cerebral said. “This is an industrywide issue that we’ve seen and experienced with pharmacies across the country.”

Cerebral didn’t respond when asked which other companies in the telehealth industry it believes are experiencing similar problems with pharmacies.

Four of the largest general telemedicine companies—

Teladoc Health Inc.,

American Well Corp.

, MDLive and Doctor on Demand—as well as four of the largest online mental-health companies—Lyra Health Inc., Ginger, Spring Health and Modern Health—don’t prescribe controlled substances via telemedicine, according to the companies.

Ahead, a telehealth provider focused on ADHD treatment, recently said it plans to shut down.

Pharmacists more frequently delay Cerebral prescriptions for administrative reasons such as when the medication is out of stock or not covered by a patient’s insurance, said people familiar with the issue at the company. Cerebral has a team of clinical administrators to work with pharmacies to resolve delays.

When pharmacists delayed or refused to fill prescriptions for Cerebral patients due to controlled substances concerns, the company’s staff sometimes encouraged patients to use a different local pharmacy or to use its mail-order pharmacy partner Truepill Inc., according to a person familiar with the process.

Some nurse practitioners at both Cerebral and Done have felt pressured to prescribe stimulants like Adderall, even though they feel the companies’ 30-minute evaluations aren’t long enough to properly diagnose ADHD, The Wall Street Journal reported last month. The companies said they encourage clinicians to use their best clinical judgment and follow evidence-based best practices.

Done has roughly 130 clinicians treating patients in more than 20 states primarily for ADHD, said a person familiar with its business. Cerebral lists nearly 1,600 prescribers on its website and treats ADHD in 24 states, though its staff also treats other mental health conditions for which they sometimes prescribe controlled substances, including depression and anxiety. A Cerebral spokesman said that “our ADHD business is a very small part of our overall client base.”

Adderall and other stimulants are a primary treatment for ADHD and can provide substantial benefits to people who are properly diagnosed with the condition, psychiatrists say. At the same time, Adderall is classified by the Drug Enforcement Administration as a schedule-two controlled substance due to its potential for abuse. For instance, the stimulant is widely misused by college students who don’t have ADHD but want to stay focused for extended study sessions, surveys show. It is also abused by alcoholics looking to counter the effects of drinking, say addiction recovery specialists.

Individual pharmacists can block controlled substance prescriptions they view as inappropriate, for instance because prescription-drug monitoring databases show a patient has already received the same drug elsewhere. Large chains including CVS have also established compliance teams that monitor their pharmacy networks for excessive prescribing of controlled substances.

Some Done clinicians had prescriptions blocked by Walmart starting last summer, and the company had enough trouble with Walmart’s pharmacies that it stopped its clinicians from sending prescriptions to the retailer, said people familiar with the internal policy.

“Some Done-affiliated prescribers have been blocked by Walmart, and individual pharmacists have refused to fill prescriptions from Done-affiliated prescribers,” Walmart said. “To date, Walmart has not yet made a decision to block or unblock all Done-affiliated prescribers.”

Around early March, Done permitted other clinicians who haven’t been blocked by Walmart to submit prescriptions to the retailer again, and those have been filled, said a person familiar with Done’s operations.

CVS recently interviewed a Texas doctor who works for Done over concerns about the volume of stimulant prescriptions he is writing. The doctor,

Christopher Lucchese,

writes prescriptions for patients seen by Done nurse practitioners with whom he collaborates, because Texas doesn’t allow nurse practitioners to write Adderall prescriptions themselves. Those nurse practitioners see slightly more than 1,000 patients among them, said the person familiar with Done’s operations.

Dr. Lucchese confirmed CVS interviewed him and said the company asked him about why he suddenly began prescribing a large amount of Adderall. Dr. Lucchese said he didn’t treat a significant number of ADHD patients before he started working for Done in 2021. Speaking of the volume of patients he sees, Dr. Lucchese said stresses from the pandemic and the nation’s political and financial environment are leading more people to seek treatment for ADHD. “Telemedicine can reach more people,” he said. “These companies make it user friendly.”

CVS interviewed another Done doctor,

Yolanda Whyte,

in December. Dr. Whyte confirmed the interview and said CVS asked her about her prescriptions because she prescribes more stimulants than her peers. She has since left Done but estimated she was handling more than 300 patients for the company.

Dr. Whyte said she told CVS that she was prescribing more stimulants because she saw exclusively ADHD patients for Done. She said that the interview resolved the issue and that CVS never declined to fill prescriptions for her.

—Elisa Cho contributed to this article.

Write to Rolfe Winkler at [email protected] and Sarah Nassauer at [email protected]